In psychiatric patients who seem convinced that their apparent delusions or hallucinations are real (ex. a patient complaining of anxiety who believes that his co-workers are conniving against him or that everyone is observing him 24/7 to obtain something against him), how do explain to the patient that you are considering a psychiatric diagnosis?
I can imagine that you would explain that you would first like to test for organic causes for the anxiety. But should you also confront the patient with the possibility that his case is "psychiatric" or that his beliefs/sensations are probably just "all in the mind?" Would you suggest a possible referral to a psychiatrist for a more thorough evaluation? And given this stigma about being a psychiatric case, what could be the most sensitive way of delivering this possible differential and this referral to a psychiatrist?
I'm asking this because it can be quite awkward to tell a patient that his beliefs are unreasonable or are probably unreal. The patient may become offended, defensive, and critical towards the doctor.
Thanks a lot!